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Safety of Patients Isolated for Infection Control
Henry Thomas Stelfox, MD;
David W. Bates, MD, MSc;
Donald A. Redelmeier, MD, MSc
JAMA. 2003;290:1899-1905.
Context Hospital infection control policies that use patient isolation prevent nosocomial transmission of infectious diseases, but may inadvertently lead to patient neglect and errors.
Objective To examine the quality of medical care received by patients isolated for infection control.
Design, Setting, and Patients We identified consecutive adults who were isolated for methicillin-resistant Staphylococcus aureus colonization or infection at 2 large North American teaching hospitals: a general cohort (patients admitted with all diagnoses between January 1, 1999, and January 1, 2000; n = 78); and a disease-specific cohort (patients admitted with a diagnosis of congestive heart failure between January 1, 1999, and July 1, 2002; n = 72). Two matched controls were selected for each isolated patient (n = 156 general cohort controls and n = 144 disease-specific cohort controls).
Main Outcome Measures Quality-of-care measures encompassing processes, outcomes, and satisfaction. Adjustments for study cohort and patient demographic, hospital, and clinical characteristics were conducted using multivariable regression.
Results Isolated and control patients generally had similar baseline characteristics; however, isolated patients were twice as likely as control patients to experience adverse events during their hospitalization (31 vs 15 adverse events per 1000 days; P<.001). This difference in adverse events reflected preventable events (20 vs 3 adverse events per 1000 days; P<.001) as opposed to nonpreventable events (11 vs 12 adverse events per 1000 days; P = .98). Isolated patients were also more likely to formally complain to the hospital about their care than control patients (8% vs 1%; P<.001), to have their vital signs not recorded as ordered (51% vs 31%; P<.001), and more likely to have days with no physician progress note (26% vs 13%; P<.001). No differences in hospital mortality were observed for the 2 groups (17% vs 10%; P = .16).
Conclusion Compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.
Author Affiliations: Department of Medicine (Drs Stelfox and Redelmeier) and Department of Health Policy, Management and Evaluation (Dr Redelmeier), University of Toronto, and Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre (Dr Redelmeier), Toronto, Ontario; Graduate School of Arts and Sciences, Harvard University, Cambridge, Mass (Dr Stelfox); and Division of General Medicine and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (Drs Stelfox and Bates), and Partners HealthCare Systems (Dr Bates), Boston, Mass.
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